Monday, September 15, 2008

Beyond the cervix....

From time to time I check in with myself on the philosophical guidelines that rule who I am as a midwife. Lately I seem to be up against a concept in midwifery that obstetrics has taught us is the cornerstone of their understanding of the laboring woman.

Midwives have intimate access to a woman's body that sometimes she herself or her partner doesn't have.

In short we have access to her cervix and its nuances. We have knowledge about how it "should" operate in labor and we have predetermined that it should open in a fairly regular pattern. Midwives worry about cervical scarring, we worry about cervical lips, we worry about effacement, we worry about swelling of the cervix, we worry about stripping the cervix of its most precious membranes, we worry about tearing of the cervix and numerous other things that have to do with the function of this very intimate organ.

And sometimes we just like to mess with it. I have had lately many opportunities to mess with women's cervices....grrrrrrrrrrrrrrrrrr

I don't enjoy it. Lately I have had a run of lovely births where the cervix has been a huge topic of consternation. I, universe, would like for that to be over please. Please ask me not to do an exam. No more cervical exams, lets trust the body please that it knows what to do, that it will take care of its own cervical lips. I don't want to push anymore back or watch someone do that at a birth.

Yes i know i careful what you ask for. Fine I am willing to deal with the consequences and have dealt with it.

At MLL in 2007 (gosh it has been over a year since I left). I took pride in creating an environment in the birth space of the woman where babies choose to glide out without but the first cervical exam upon intake in labor.

I caught many babies on my knees with the woman standing, where the mom almost as a reflex pushed her baby out. NO cervical exams to check that she was fully dilated, no moving back cervical lips. Hands out of the vagina and hands off the cervix.

I love to watch a woman labor when she is left alone....

It generally goes like this: in active labor her contractions start, they stop, the start, they stop, they ebb and flow and get longer and more intense, a woman is upright, she follows the roll of the waves of the contractions, she whispers, she moans, she prays, she leans on someone or something when the contraction peaks.

The midwife is patient, she doesn''t bring her worry into the room. She checks all of the necessary vitals and babys heartbeat in a non invasive way. She asks permission, she uses a quiet voice, she doesn't bring other peoples fear into the room.

If a woman is not asked to lay down for a cervical exam, no one knows what her cervix is doing in these moments....only the cervix knows.

She continues in this pattern of changing positions, upright and walking is usually the position of choice unless someone tells her that there are better positions.

If she has not read a book or seen a poster about different positions for laboring, she will naturally choose the upright and walking position. Contractions space closer together, perhaps one on top of the other.

Then there is a pause, she stops walking in some point in her labor and begins to bend her knees at the peak of contractions. She is immersed in the process, she is internal, she is breathing and sweating and possible moaning.

She is not pushing, she is bending at the knees, not in a complete squat, but halfway there. Sometimes a woman may bend at the waist and hold her partner and then squat. No one has told her to do so.

I love it when this happens. The baby is probably coming soon, better put on gloves.

Put on gloves.

Next contraction here it comes... another deep bend at the knees and then sometimes......a huge splash, fluid possibly poop from the mom comes. It can be mighty messy.

This is usually followed by a very intense, very long grunting push.

Sometimes the baby crowns here, sometimes that one push is enough for the baby to be born.

I love births like this. I actually had one birth where the mom got up after trying to rest a bit, squatted a bit and the baby slid out onto the bed. I heard the cry. She was still in her nightgown, I guess she had her underwear off! I did not see the baby born just heard the cry behind her.

I wasn't being negligent, I didn't know the baby was coming. She pushed once, one deep down reflexive push. BORN!

Midwives talk about the fetal ejection reflex. It exists, I have seen it over and over and over and over again. I love it, it makes me gives me joy because the woman has done it, no one has told her body that it is ready. No one has checked her cervix, messed with a lip, worried about it swelling or tearing. A woman doesn't even know to push, it just happens and then the baby is born, ususally to a surprised bunch of people.

Go cervix, go mamma, go fetal ejection reflex. The body is an amazing thing and it deserves respect for its wisdom.

Once when I was a new doula a mom had a particularly intense back labor and was getting frustrated. She got up to go pee and then looked at me. She asked me pointedly hanging on the door handle to the bathroom. "When will I know when to PUPPPPPPPPPPPPPUUUUUUUUUUUUUSSSSSSSSSSSSSSHHHHHHHHHHH" in a very deep gruntly sort of way. My response "um I think you are"
"NO I am noooouuuuuuuoooooooooooottttttttt"
the baby was born shortly thereafter.

Is this turning into a rant? Perhaps, but I am just affirming to myself my original desire to be as hands off as possible.

Do you think all midwives start out with this desire and then experience makes them want to always check a woman's cervix?

Say for example if you missed a breech? Would that cause you to do more exams? Or say you had a once upon a time super long push because the cervix was still having a stubborn lip....that wouldn't budge. NOOOT that I have had any of those experiences uh hum....

I know that we are formed by our experiences, there is a saying in the birth world. " We are a product of our last 5 births" I would like that not to be true.

OK universe? Lets leave the lip alone and it will melt away. Lets be patient and ask the mom to wait for her next exam. Lets not touch what works so perfectly until we see signs that it might be getting tooo tired and not grunty enough, and after that wait some more. Lets protect the birthing environment, let our anxiety go before we open the front door. Lets keep the lights low and wait.

Tuesday, August 19, 2008

My Beautiful Cervix

A different View

My beautiful cervix is an amazing photo journalistic site on changes that a student midwife goes through in her menses.

It is bold and the photos are amazing. I think it is brilliant but others might think it is a bit graphic. I invite any human being to explore that idea and probe deeper into the belief system that might interpret these photos as taboo or gross.

I think that every woman should feel as comfortable as this woman does taking those photos, to explore her body and sit in awe of its beauty. She even got her partner to help out! Amazing.....

Wednesday, July 2, 2008

As normal as Birth

As normal as breathing, as normal as a birthday celebration, as the 1st day of kindergarten, as a 1st kiss or a 10 year anniversary.

We made the acquaintance of some people from the Netherlands and the subject of midwives came up.

"You know, homebirth is a normal thing to do in the Netherlands"

Sigh...yes I know and normal in the UK, in Norway, in Denmark, in New Zealand, in Canada etc..

In fact we rented out house to two couples from Europe on two separate occasions who had told the story of how it was the middle of winter and no one wanted to go out to midwives car to get the birth stool because it was too cold. She spoke of how when someone finally got the chilled stool for her, the cold felt delicious because she was so heated up from labor.

Sigh...I am completely jealous of that midwife, that is most likely the least of her worries. Too cold to get the birth stool. She doesn't have to worry about the AMA, or physician supervision, or prosecution or client base.

A completely normal option for low risk women.

To be in a place where birth is considered a normal function of life...sigh...

I know that homebirth can be empowering and spectacular and transformational and spiritual and a gentle transition for the baby.

But for it to be just normal for families is an often overlooked thing.

Homebirth is completely normal, it is the most natural thing to occur for a family. I have said that to homebirthers and they sort of look at me strangely because here it is such a radical thing to do for many people.

My greatest wish if for everyone to have a normal birth, if it is empowering, transformational, beautiful, gentle, marathon like but rewarding...if it is any of these things great! But normal...yes, just plain normal for families would also be

well you know....fill in the word here ___________________

It should be normal for families to be the first ones to speak to, hold their child, and even be the first to touch their baby's head.

It should be normal for a woman to feel the physiologic urge to push, and push when ready not when she is deemed by someone "complete and ready to push"

It should be normal for children to witness their new family member emerging and to be in wonder, not fear about a new baby coming home from somewhere that they have no association with.

It should be normal for grandmothers mothers or to put a damp washcloth from her own bathroom against their granddaughter's /daughter's head and tell them that yes, this is hard and yes "you can do it."

It should be normal for a woman to vocalize in labor and not worry who is hearing through thin walls.

It should be normal for the mother to know everyone in her space and not worry about who will see her/hear her in such a vulnerable state.

Birth should be normal.

Monday, June 23, 2008

Full Moon

It has been so long since my words flowed onto these pages, I think the change to this blog was a bit premature. My El Paso Adventure in becoming a midwife was not over, is not over, it just is no longer in El Paso. I have found myself quiet because my struggles are so very internal right now. I felt the urge to bounce some of them out there in cyberspace today to your listening eyes and hearts.

I have taken all of my exams, finished all of my paperwork, a just waiting for the medical board to declare that everything is in order and give me a license #.

HA! For whom does that make me a midwife? In the legal sense I suppose.

My adventure into "becoming" a midwife is beginning, and like life in its constant state of flux. Some will say that you are a midwife always in process and that a piece of paper is just that: a piece of paper.

Crossing thresholds in life becomes solidified when there is a ritual to make it real for the person. When I left MLL, a group of us got together to have a lovely symbolic tattoo done on our ankles. A waxing moon symbolizing fertility and a full moon for those who had become mothers. In the future, we will add a waning moon to the onset of menopause, and become "crones". This was profound for me, most of the midwives at MLL have these very same tattoos. A few have all three moons. In a strange way I now look forward to the day that I have my waning moon.

I now find myself on the brink of having a piece of paper in my hands that says I have completed all of my legal requirements to become a midwife. I wish it were a tattoo, a more ancient symbol of threshold crossing. Something not floating nebulously in my hand but something etched into my skin.

I do feel like a midwife though. I don't feel like I need a tattoo, I just need a ritual to cross the threshold, for it to feel solid.

It is the human body that needs to feel its way through experiences, it is our minds that need the paper. Well not quite but your get the gist. I tend to feel my way through things with my senses, my most basic instincts.

For example, when I touch a belly to feel for the position of a baby, I do not generally visualize in my mind what I am feeling as Left or Right but sculpt an image with my hands that transmits a position to my brain but it takes awhile for it to form into words. I laugh at myself often because it takes me awhile to get whether the back is "right" or "left" or "anterior" or "posterior". I know the position, I have felt it, my hands know it but my darn brain takes awhile to convert it to a term that is appropriate for a chart or someone who wants to know what it is that I am feeling.

We are taught to chart all of this LOP, LOA, ROA, ROT, transverse, breech but the body feels so much more.

I feel my way things very well in birth and prenatally. I have the muscle memory for skills. I have handled complications well, have handled many a normal birth well. My brain is wrapped around emergency procedures any my hands work well in those times.

So I feel it in my body, the settling in of this title of "midwife". And it is more definitive that a piece of paper from the medical board.

Tuesday, January 8, 2008

Community Birth

Kneeling Woman has a thread on community midwifery...something I have been pondering for awhile. I have been thinking that it is impossible, to be a community midwife in this place of over a million people. The wonders of community midwifery seem to be an illusive dream, that catching my neighbors baby only would exist in a smaller, more intimate space...until recently. I have come to think that there is a strong need for a re-vamping of the definition.

And then yesterday I was at the park with a friend and her children and out of the corner of my eye I saw a father and his two year old bundle of energy. I looked a little closer and there was a spark that I knew this person...Oh my...I had been at the birth of this two year old boy. The dad gave me a huge embrace and we began talking like we had known each other all of our lives.

I don't think this dad ran up to women in the park and embraced them often. The kind of instant intimacy that people develop in birth is mysterious and lovely and lasting. It felt good to see them and later on I stopped by to say hello to the mother as they had moved within 500 feet of our house.

The universe just clunked me on the head as if to say "Take another look Sunshine"
It was so nice to see this little angel running around. This is the 1st time this has happened to me(that I have run into someone in my neighborhood whose birth I have been to). I live in a bubble sometimes.

I have been rolling many ideas around in my head, hoping that they would form a coherent piece of writing, but really as I write the process generally unfolds. It is not edited very much really and tends to come from ...well I don't know exactly where it comes from. Follow me through these next few paragraphs and see where it goes. It is process of understanding my perceptions and working through them. Find out where your truth meshes with mine or separates completely.

One of the things that I try to understand is the basic need for community. I grew up in many Hawaii, where the word Ohana (I know, some of you immediately think Lilo and Stitch) means an extended family, not just blood relations, but those people in your life who are close in other ways.

And then I became an adult in Southern California where I got the sense that everyone leads separate, independent lives, where I didn't know my neighbors. I have followed that model, I am afraid, for a long time. I had trouble keeping friends, had trouble as a new mother, finding and creating a circle of friends. It wasn't that I didn't get along with people, it was that I didn't know how to be who I am, around people that I don't know that well. I was/am terrified of being judged for being out of the mainstream, for being different, for being a teenage mother, for co-sleeping, for this...for that...the list could be endless. At time it is/was heartbreaking, I went through the standard feeling of being isolated, feeling that people were uncaring, cold, flaky...or even worse, that I was unworthy, that there was fundamentally something wrong with me. I also chalked it up to being a loner...I had spent much of my childhood as a only child and spent a lot of time in books and playing by myself.

And then...well last year happened yes, but many other things. I was thrown into a place where any damm insecurities I had were under a microscope. I was in a situation where I had instant community like it or not. (if you are visiting my blog for the 1st time, that experience is documented here)
And I discovered something... I got along with people even when there was conflict, even when I judged and when I was being judged. There were definite tensions, yet my life was richer for it.

So my ideas about community have evolved. I feel a bit sheepish for something that seems to be so simple, yet so out of my reach conceptually. I was so guarded in my life that I missed out on a lot of things.

It wasn't that San Diego had a lack of community, it was that I had the idea that community was something you were born into, that community was a group of individuals that were like you, than a community selected you somehow, to be worthy of being part of it. Sometime when I write things out of my head I think I am an absolute_______ (fill in blanks)


So here is to a new definition of community in evolution. What is yours?

Sunday, January 6, 2008